Double vision is a visual disturbance. visualizes one object in two The two images may be close to each other or very far apart.
Normally, the two eyes look the same. and roll in different directions at the same time in order to see only one clear image if there is an abnormality that inhibits eye roll It could be the muscles, nerves, or the brain stem, causing the two eyes to see differently. and eye rolls are not related can cause double vision Common causes such as tumors, aneurysms Nerve inflammation, ischemia, accident, muscle weakness thyroid eye muscle slack due to age, etc.
There are 6 eye muscles on each side, up-down/in-out. /counter-clockwise Controlled by cranial nerves 3, 4 and 6, 3 on each side of the brainstem.
When there are symptoms of double vision An important history to help in the differential diagnosis is blurred vision when looking with one eye or both eyes, the direction of the diplopia. Is there a constant overlap in each direction, time since symptom onset? duration of change, accompanied by other symptoms such as pain and blurred vision
To distinguish between double images when looking with one or both eyes The patient will be asked to close one eye at a time and look. If you look with one eye at a time and overlap Shows that it is double vision caused by one eye. The cause may be dry eyes, cataracts, short-sightedness/long-sightedness/astigmatism that has not been corrected. But if you look with one eye at a time, the double image disappears. But look with two eyes and see double vision. It is caused by one eye being positioned differently, usually due to
The eye muscles are not centered. The nature of double images may be seen as a left-right, top-bottom, oblique line.
Causes of dangerous diplopia include: 1. Diploma of blood vessels Diplopia often occurs suddenly within 1 week, may or may not have pain in the eyeballs / head. There may also be ptosis. Which is caused by the 3rd pair of nerves being pressed. At first, it may be double images, both left-right, top-bottom, oblique if the blood vessel is broken. Bleeding under the cerebral cortex will be fatal Therefore, if symptoms Let’s hurry to the hospital immediately. 2. Infection Double vision symptoms are increasing in 1-3 weeks, often with pain behind the eyeballs / head. Caused by infections such as sinusitis often The tissue behind the eyeball is destroyed. If the infection spreads to the vision Even after treatment, it may not be able to see as clearly as before. 3. Tumors such as cancer behind the eyeball. Affects nerves 3, 4, or 6, causing pressure in the eye sockets. unable to roll eyes Or there may be a brain tumor. cause high pressure in the brain Causes the 6th pair of cranial nerves to be weak, causing double images on the left-right side. Often accompanied by brain symptoms such as trembling, trembling hands
Other causes that are more common include: 1.Myasthenia Gravis, muscle weakness often have droopy eyelids There may or may not be double images. Usually there are different symptoms during the day, there may be provoking factors such as illness, certain medications. Confirmation of the diagnosis depends on various laboratory tests, but in some cases, if the symptoms are mild May not detect abnormalities in the laboratory at all. Especially if the weakness is only in the eyes. Additional examination by placing ice on the eyelids may improve nerve transmission. droopy eyelids look elevated or missing images Helps in diagnosing muscle weakness, in some cases it may be possible to treat and make follow-up appointments. Many patients if the landscape is better Double vision may disappear. 2. Nerve ischemia Often caused by congenital diseases such as poorly controlled high blood pressure, diabetes, high blood lipids. long smoking Most of the symptoms will start to get better in 1 month and will disappear in about 3 months or more. If it doesn’t get better in 1 month, you need to find out if it’s from other causes such as inflammation, tumors, etc.
Side-by-side look -> Suspected as a 6th nerve ischemia.
Stooping, tilting your head, if you look straight ahead and see oblique double images -> suspected to be a lack of blood supply to the 4th nerve
Droopy eyelids, inability to roll eyes inward/upper-lower But the iris still responds well. The duration is about 1 week -> usually the 3rd pair of nerves is ischemic.
squinted eyes from long staring Caused by using too much eyes to look at a computer screen, eye fatigue, double vision symptoms will disappear. very late at night after working all day Spasms of the pupil may also occur. The duration is often a long time. treatment by rest reduce computer use and follow-up with an ophthalmologist
The importance of caring for patients with double vision is the correct diagnosis. Because the cause of the symptoms are double vision. There are a lot of things that are life threatening. But many things are not dangerous, with doctors finding causes that are fatal first. Treatment guidelines will fix the cause first. relies on the cooperation of
Ophthalmologist, internal medicine-neurosurgeon otolaryngologist which diagnoses the cause Many methods must be used together, such as blood tests, brain scans, electrocardiograms, etc., but there are some diseases that may be examined further and nothing can be found. The assumption and follow-up method is mainly used. or if moving to the hospital Should ask for the results of the examination as well due to the care of patients with double vision Continuous follow-up assessment is important. It is not advisable for some patients to change doctors. or move to the hospital on their own because there may be redundant examinations and exposure to excess radiation
Treatment for blurred vision Depending on the cause, for example: 1. Surgery for tumors. May be able to cut only some parts and then continue with chemotherapy. to reduce the size of the tumor Blurred vision can be reduced. 2. Taking medicine in patients with double images from muscle weakness 3. Give antibiotics, anti-inflammatory drugs if double images are caused by infection, inflammation. 4. Treat myopia / long / leaning. that has not been fixed corrected by wearing a lens
However, after completing the treatment according to the cause If double vision persists there is a solution to reduce double images depending on the distance of double images or the corner of the eye The doctor will choose the treatment method such as prism glasses, eye muscle surgery. Botulinum toxin injection into the eye muscles The doctor will treat it by focusing on visualization in the center of the visual field to not have double images. If the patient looks straight and does not overlap But when looking to the side, there is a double image. usually not treated but let the patient practice and adapt
Narrated by
Asst.Prof.Dr.Niphat Euaaree Neuro-Ophthalmology Club
Dr. Techawit Likhitkorn Neuro-Ophthalmology Club
Compiled by Dr. Naphasakorn Sulaimanee, M.D.
2023-09-01 23:00:00
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